Expert guidance for inducing lactation, relactation, and co-lactation now covered by insurance
I am excited to share that I am now partnering with Lactation Consultants of America (LCA) to cover consultations with most insurance providers!
Out-of-pocket costs. For insurance-covered clients, I charge a one-time concierge fee of $195 per parent/baby dyad to be paid directly to me when booking your initial consultation. In addition, your insurance may require a co-pay or cost-sharing of $10-$30 per consultation. (Aetna may require additional cost-sharing of $60 per consultation when baby is present.) Any co-pays or cost-sharing will be collected by LCA.
There are several ways to check your insurance coverage before booking:
- Call your insurance company and ask if you have lactation benefits. Specifically ask if they cover procedure code S9443 and diagnosis code Z39.1. Get a confirmation number from the call
- Call Lactation Consultants of America to talk to Mary (323) 870-1150 7:30am-4:30pm Pacific Time. She will need your insurance information and date of birth of the policy holder
- Email Alyssa with a picture of your insurance card
You may also choose to book without confirming insurance coverage first. In this case, LCA will bill you directly at insurance rate if your insurance does not cover lactation consultations.
Number of consultations covered. In most cases, there is no limit to the number of lactation consultations covered. With Aetna and Tricare, the number of pre-approved lactation visits is 6. Meeting frequently as needed throughout this process allows you to receive the highest level of support as we navigate your journey of inducing lactation, relactation and/or co-lactation as a team. I typically recommend at least 4 consultations.
Other considerations. Getting coverage with Lactation Consultants of America requires additional administrative work from both the lactation consultant and the client. You will be required to complete additional consent forms and screening intakes. You may also receive many automated emails from LCA (which you should be able to opt out of). And, finally, working with LCA is new for me. As always, I will do my best to communicate clearly and openly, but there may be some bumps in the road!
Frequently Asked Questions
The following insurances are typically accepted:
Aetna
Anthem
Blue Cross Blue Shield
Centivo
Cigna
HealthNet
Prime Healthcare EPO under Blue Shield of CA
Tricare West
United Healthcare/UMR
...as well as some other smaller plans. With these or any plan, it is recommended to check your benefits (as described above) before booking. If you book an insurance covered package (versus self-pay) and your policy is not covered, LCA will bill you for the contracted insurance rate.
This fee covers helps me to get compensated at the same level for my clients covered by insurance as those who are self-pay. But it also benefits you, the parent. One concern holding me back from extending my coverage with insurance was that my past clients covered by insurance often had poorer outcomes than my self-pay clients. I believe this is because my self-pay clients were required to make a higher level of commitment to their lactation plan by making an upfront financial investment -- they had more skin in the game, so to speak.
At this time, any plan covered through Lactation Consultants of America accepts telehealth.
Inducing lactation consultations (which take place before baby is born) are considered prenatal consultations with insurance. I anticipate possible difficulty covering non-birthing parents when there is no due date to report to the insurance company. This may be an issue for prospective adoptive parents not yet matched. If this is your circumstance, we can discuss your options during a free 15-minute phone "mini" consultation. You can schedule that HERE.
Co-Lactation
If parents plan to co-lactate, both parents should request insurance coverage. If only one parent has coverage through LCA, I can offer the other parent my services pro bono as part of my mission as an inclusive practice as long as the parent whose plan is covered by LCA completes the necessary intake and consent forms and participates in each consultation. Whether one or both parents are covered, each parent/parent/baby triad will be charged a single one-time concierge fee.
Gestational Carriers
If baby is arriving via surrogacy and the gestational carrier will be providing milk for baby, I can meet with her to discuss establishing lactation and pumping, storing, and shipping milk. Although I would not charge an additional one-time concierge fee, the GC would have to be covered under her insurance unless the intended parent choses to self-pay for her consultations.
I often collaborate with local lactation consultants to give parents the best of both worlds! I provide expert guidance on inducing lactation, relactation and/or co-lactation and a local lactation consultant helps with pump rental, flange fit, latching and positioning once baby arrives and referrals to local resources. I love collaborating with local LC's. The only hitch with insurance coverage is that you cannot meet with both lactation consultants on the same day and get coverage with both.
You can book your first inducing lactation/relactation consultation and submit your one-time concierge fee HERE.
Any additional questions? Feel free to email me or schedule a free mini consultation!